Additional Instructions Improve Follow Up Rates for Emergency Eye Patients

Providing ophthalmic patients with both written and verbal instructions, telephone calls, and mailed letters could improve follow-up post emergency department (ED) visits, according to a study published in American Journal of Ophthalmology. Increasing follow-up rates is important for patients who are young, insured, unemployed, and present with nonvision-threatening conditions, as some eye conditions progress quickly and irreversibly. 

The prospective interventional study consisted of 2 study arms: control and intervention. The control arm protocol, for which data was collected between January 2013 to May 2017, consisted of the consulting ED resident providing verbal instructions only to patients. The intervention arm protocol, which was collected from December 2017 to March 2019, implemented 3 additional to the verbal instructions: A paper handout at the end of the ED consultation, a phone call from the clinic receptionist within 24 hours, and a mailed letter within 48 hours if the patient did not respond to the phone call. 

A total of 763 patients in the control group (mean [SD] age, 43.4 years [16.0 years]; 63.8% men) and 199 patients in the intervention group (mean [SD] age, 44.9 years [15.9 years]; 64.3% men] were enrolled in this study. The follow-up rate was lower for the control group than the intervention group (42.9% vs 68.8%, respectively; P <.001). Follow-up rates increase significantly for all subgroups except for patients aged 18 to 29 years, those who were uninsured, or those who were unemployed. The strongest predictor of presenting for follow-up was having health insurance, having a diagnosis severity class of IV, and having received the intervention. 

“Increased follow-up instruction by means of a handout, telephone calls, and mailed letters was demonstrated to increase the likelihood of follow-up after primary ophthalmic consultation in the ED, when compared with only verbal instruction,” researchers explain.

Due to poor enrollment of patients with financial aid, patients paying with workers’ compensation, and patients with unknown employment status, it is unclear whether these groups benefited from the intervention, according to the researchers.

The primary limitation of the study was that the control and intervention group was collected in serial rather than in parallel. The control group was collected retrospectively while the intervention group was collected prospectively, in a nonblinded fashion.